Permit CITY OF TIGARD PLUMBING PERMIT
1111
s: COMMUNITY DEVELOPMENT Permit#: PLM2022-00446
Date Issued: 11/1/2022
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S112DD01000
Jurisdiction: Tigard
Site address: 15700 SW UPPER BOONES FERRY RD
Project: Tigard Suites Hotel Subdivision: None Lot: None
Project Description: 40'of storm sewer and (2)backwater valves only. NO other site plumbing included on this permit.
Contractor: INTERLAKEN INC Owner: BHGAH TIGARD LLC
PO BOX 2010 5895 JEAN RD STE 100
FAIRVIEW,OR 97024 LAKE OSWEGO, OR 97035
PHONE: 971-404-9244 PHONE:
FAX:
FEES
Quantity Description Date Amount
40 If Storm Sewer 11/01/2022 $62.54
Specifics: 2 ea Backwater Valve 11/01/2022 $25.02
1 12%State Surcharge- 11/01/2022 $10.51
Type of Use: COM Plumbing
Class of Work: NEW
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: ✓7( [ n y ../ / Permittee Signature:
/ --Xll"///«l %%%Caalll///503.639.4175 by 7:00 a.m.for the next available inspec on date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
PlumbinE Permit Application
•
Site Utilities FOR OFFICE USE ONLY
City of Tigard Received i /,,
We/BY: IIiii1 ,W9- } Permit No.:pi frit2r44 ..,ociiCleo
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
0 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: luris: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FIE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description j_ Qty. Ea. Total
O Additionialteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
El1-and 2-family dwelling A Commercial/industrialSFR(2)bath 437.78
ElAccessory building El Multi-family
SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
sv
Job site address: Catch basin or area drain 18.76
15700 urfee aoovke-s y o�i
6
City/State/ZIP: LA Ke 0 S J o 10 le_ 17035 Drywall,leach line,or trench drain 18. 2
/ Footing drain(no.linear ft.: Page 2
Suite/bldg./apt.no.: I Project name: 7l'tl4 e t em C 5, 4.4 Manufactured home utilities 50.03
Cross street/directions to job site: ✓ Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_J Page 2
Storm sewer(no.linear it:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve Z 12.51
Clothes washer25.02
` �1\L N t Dishwasher 25.02
s A" C h17 t
Drinking fountain 25.02
/ J
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: & r(i 5 Floor drain/floor sink/huh 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:Hi{'' ) 1(0-t c(2,,, Fax:( I Ice maker 12.51
,®' APPLICANT. ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: ,,15� C.OvlS-1-vu 'ion CO tA't OtteN Medical gas(value:$_) Page 2
Primer 12.51
Contact name:
'vtr eri 5e.A [_,,,ry q Alex Jckvi se n Roof drain(commercial) 12.51
Address: 122 MAIbt 51. Sink/basin/lavatoty 25.02
City/State/ZIP: 0 yr, ,to r i / t 0 0., 9 70 Li5 _ Solar units(potable water) 62.54
Phone: 503 (,o-7 ( ax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:. e ;5aylsetnCon51-rJ�.}/s.,C0✓`IpC•cl4 Cot",
f --1 Water closet 25.02
a.'lrn'-=�.1 CONTRACTOR
` I Water heater 37.52
+
Business name: ,�.}er c..tKein Water P IPto&DW V 56.29
Address: 2_0 Z 6 W i• , , •, • e Other: 25.02
city/State/ZIP: G,fesk,k4,,.t 1 0 t Io3o Subtotal
Fax: Minimum permit fee: $72.50
Phone:(503) 674 - lyGo (503 ) (,7q - 70zo
CCB Lie.: I(ap 01 6. ,01191.1 Plumbing Lic.no.: p 5I I$Q Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE q 8,01
Print name: Gorr i Sark G..41t Date: (1/1 /2_2 This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1Building\Peneits\PLMU-PermitApp.doc 10/01/09 440-616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard ' .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 4
Y untjon,::, . . ermit,Fee: ,,. , _
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
QtheralnspectonS or Fees and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$L45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type part..Review.for.Plumbin' Installations
Fixture Type for Replace/
P Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool
pool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
-4" Isometric or Riser Diagram
Car wash Drain 0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Iav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
1:\Building\Permits\PLMU_PermitApp.doc 2
d
Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional,drawn
to scale) labeled with:
A. 0 map&tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name El phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS-Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location, pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:1Building\Permits\PLMF-PexmitApp.doc 12/30/05